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Tolerance and efficacy of rituximab and changes in serum B cell biomarkers in patients with systemic complications of primary Sjögren’s syndrome

Raphaèle Seror¹, Christelle Sordet², Loic Guillevin³, Eric Hachulla⁴, Charles Masson⁵, Marc Ittah¹, Sophie Candon⁶, Véronique Le Guern³, Achille Aouba⁷, Jean Sibilia², Jacques-Eric Gottenberg^1,*, Xavier Mariette^1,*

¹ Department of Rheumatology, Hôpital Bicêtre, Assistance Publique–Hôpitaux de Paris, Université paris-Sud 11, INSERM U802, Le Kremlin Bicêtre, France
² Department of Rheumatology, Hôpital Hautepierre, Strasbourg, France
³ Department of Internal Medicine, Hôpital Cochin, Université René-Descartes Paris 5, Assistance Publique–Hôpitaux de Paris, Paris, France
⁴ Department of Internal Medicine, CHU de Lille, Lille, France
⁵ Department of Rheumatology, CHU d’Angers, Angers, France
⁶ Department of Immunology, Hôpital Necker, Assistance Publique–Hôpitaux de Paris, Paris, France
⁷ Department of Hematology, Hôpital Necker, Université René-Descartes Paris 5, Assistance Publique–Hôpitaux de Paris, Paris, France

Correspondence to:
Professor X Mariette
Service de Rhumatologie, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; xavier.mariette{at}bct.ap-hop-paris.fr

Objective: To investigate the safety and efficacy of rituximab (RTX) for systemic symptoms in patients with primary Sjögren’s syndrome (pSS), and changes in B cell biomarkers.

Patients and methods: The records of 16 patients with pSS according to the American European consensus group criteria were reviewed retrospectively.

Results: Patients, all women, had a median age of 58.5 (range 41–71) years and a disease duration of 9.5 (range 0–25) years. RTX was prescribed for lymphoma (n = 5), refractory pulmonary disease with polysynovitis (n = 2), severe polysynovitis (n = 2), mixed cryoglobulinaemia (n = 5), thrombocytopenia (n = 1) and mononeuritis multiplex (n = 1). The median follow-up duration was 14.5 (range 2–48) months. Three patients experienced adverse events, including one mild serum sickness-like reaction with the presence of human antichimeric antibodies. Efficacy of treatment was observed in 4 of 5 patients with lymphomas and in 9 of 11 patients with systemic involvement. Dryness was improved in only a minority of patients. Corticosteroid dose was reduced in 11 patients. RTX induced decreased rheumatoid factor, -globulin and ß2-microglobulin levels, and the level of B cell activating factor of the tumour necrosis factor family (BAFF) increased concomitantly with B cell depletion. Five patients were re-treated, with good efficacy and tolerance, except for one with probable serum sickness-like reaction.

Conclusion: This study shows good efficacy and fair tolerance of RTX for systemic features. In addition, RTX allows for a marked reduction in corticosteroid use. Except for BAFF, the level of which increases, serum B cell biomarker levels decrease after taking RTX. Controlled trials should be performed to confirm the efficacy of RTX in pSS.

Abbreviations: BAFF, B cell activating factor of the tumour necrosis factor family; FITC, fluorescein isothiocyanate; HACA, human anti-chimeric antibody; pSS, primary Sjögren’s syndrome; RTX, rituximab

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